What does Excludes 1 mean for a Chiropractor?

Have you ever wondered what an ‘Excludes 1’ note on ICD-10-CM means? Or, perhaps you are wondering: What does Excludes 1 mean for a Chiropractor?

This note can cause a lot of confusion, and if it is not properly applied, can cause claim denials and delay YOU getting paid for the services you have rendered (and no one likes that)!

An ‘Excludes 1’ note in ICD-10-CM means that the DX code excluded should never be used at the same time as another DX code above the ‘Excludes 1’ note. For example, the code low

back pain, other, and sciatica of low back strain are considered one within another and would therefore be denied as Excludes 1.

To avoid claim denials, providers should carefully review the ICD-10-CM coding guidelines and make sure that they are using the correct DX codes for their services. They should also be aware of the ‘Excludes 1’ notes and avoid using codes that are mutually exclusive. Properly Diagnosing the patient with the most accurate DX codes and without “over diagnosing” them will help avoid these denials.

Not all states are denying for Excludes 1 but it is important to note that many states are adopting this update without notice to providers. Staying up to date on coding guidelines, even before they hit your state, is something your billing team should be making you aware of in order to prevent denials from happening.

One of the first few states to adopt this change and start these denials was Illinois back in 2022. At that time, the IL Chiropractic Society in partnership with PayDC EHR released a video sharing information about the Excludes denials and how to handle them. Here is that video if you would like to learn more: https://www.youtube.com/watch?v=9yLmmarPf18 

Another great resource that can help you determine if you are in violation of ‘Excludes 1’ are online coding services such as www.findacode.com. Here you can easily search your DX codes and it will provide a comprehensive list of which codes are excluded. More importantly, a service like this or understand better the coding denials within Excludes 1 will help save time in insurance phone calls and will avoid delays in claim processing.

If you have more questions about how to avoid the ‘Excludes 1’ denials, or want to make sure you are using the correct codes for all the services you provide, then we invite you to connect with our team of experts by booking a consultation today! You can schedule a free discovery call with us by going to www.bushidobilling.com.